In Reply.—I agree with Tanz and Shulman that there is a need for an operational definition of the GAS carrier state, and, in fact, I have proposed an operational definition similar to the one they have used.1 I also agree that it is not necessary to routinely identify carriers, but there are some circumstances in which identification and termination of the carrier state would be desirable.1 These situations would include the following: families in which there is an inordinate amount of anxiety about GAS; families with a history of rheumatic fever; families in which "ping-pong" spread of GAS has been occurring; outbreaks of GAS pharyngitis in closed or semiclosed communities; and cases in which tonsillectomy is being considered only because of chronic carriage of GAS.
GERBER MA. Group A Streptococcal Carrier State-Reply. Am J Dis Child. 1988;142(10):1020. doi:10.1001/archpedi.1988.02150100014003